Post-transplant hypertension in the absence of rejection or recurrent disease

Post-transplant hypertension was reviewed in 86 consecutive renal transplant recipients and occurred in 86 percent. In order to eliminate concomitant causes, those 16 of 86 patients in whom there had never been any rejection episode nor any recurrent diseases were further evaluated for the presence of hypertension. Follow-up period was 1-5 years. All 16 patients were hypertensive in the first postoperative weeks. Nine patients, all with various nephritides, had pre-transplant hypertension, leading to pre-transplant nephrectomies in 5. Post-transplant, all 9 were hypertensive in the first 6 months. By one year post-transplant, blood pressure had normalized in 2 and was controlled on medication in 5 others. In contrast, none of the 7 other patients (all with structural lesions) had pre-transplant hypertension though three had pre-transplant nephrectomies. Only 2 of these 7 patients had post-transplant hypertension, mild in both. The experience demonstrates that prior hypertension correlates positively with post-transplant hypertension, irrespective of native kidney nephrectomies. Patients with previous nephritides carry the greatest risk of becoming hypertensive. Furthermore, the majority of young renal allograft recipients appears to develop hypertension, even in the absence of rejection or recurrent disease.